Amsterdam, NY · Montgomery County
Building Permit Homeowners Affidavit
This affidavit lets eligible homeowners of owner-occupied residences document a workers’ compensation coverage exemption when applying for a building permit.
What this form is
The form is for owners of one- to four-family, owner-occupied residences who are listed as the general contractor on a building permit. It asks the homeowner to identify why they qualify for an exemption, certify the property and work details, and provide a signature, date, telephone number, and property address. The text says homeowners hiring paid workers for 40 or more hours per week must provide coverage proof instead.
Who needs it
A homeowner listed as general contractor on a building permit for an owner-occupied one- to four-family residence may file this affidavit if an exemption applies.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document has no notary block; its text says the form serves as an exemption once notarized, but does not describe how to obtain notarization.
How to submit this form
- 1
Download The Affidavit
Download the Building Permit Homeowners Affidavit PDF.
- 2
Complete The Form
Select the applicable exemption and provide the requested certification, signature, date, telephone number, and property address.
- 3
Gather Supporting Proof
If you hire or pay individuals for 40 or more hours per week, the form says to provide appropriate coverage proof instead of filing this affidavit.
- 4
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What is the Building Permit Homeowners Affidavit for?
- It lets eligible homeowners of owner-occupied one- to four-family residences certify why they are exempt from providing specific proof of workers’ compensation coverage.
- Who may file this affidavit?
- The form describes homeowners listed as general contractor on a building permit for an owner-occupied one- to four-family residence who meet one of its exemption conditions.
- Do I need a notary for the Building Permit Homeowners Affidavit?
- The form has no notary block, but its text says it serves as an exemption once notarized. It does not explain how to obtain notarization.
- How do I submit the Building Permit Homeowners Affidavit?
- Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Building Permit Homeowners Affidavit doesn’t need a notary — but if you have another Amsterdam form that does, a commissioned online notary can help.